clinical diagnostic assessment 3-19...
TRANSCRIPT
Global Back Care Clinical Diagnostic Assessment Template
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Global Back Care Clinical Diagnostic Assessment Template
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PREFACE The Clinical Diagnostic Assessment of Joint and Muscle Pain is a musculo-skeletal health program developed by physical educator, John Miller. It is designed to provide individuals, workplaces, health and workers compensation insurers medical, fitness and manipulative therapy practitioners with an assessment of the likely causes of personally-generated musculo-skeletal dysfunction, particularly lower back dysfunction. It’s only after people have received a Clinical Diagnostic Assessment report aimed at determining the likely cause of particular joint or muscle dysfunction that anyone can prescribe an appropriate treatment program to restore poor function to good. Without the best possible diagnosis of causality, the rehab prescription is likely to be ‘pot luck’, with the treatment frequently directed at the site of the pain and not the site of the underlying cause of the pain. There are six phases in this clinical diagnostic assessment: 1. Introduction 3 2. Indemnity 5 3. Personal information 6 4. Outline of our problem 7 5. Specific joint condition assessment 8 6. Ten Point Risk Screen 9 7. Postural analysis 11 Musculo-skeletal Health Clinical Diagnostic Assessment Template © Miller Health Pty Ltd John Miller 7 Salvado Place, Stirling ACT Australia 2611 ABN 85 073 392 686 [email protected] (02) 6288 7703 61 2 6288 7703 (0424) 391 749 March 2019
Global Back Care Clinical Diagnostic Assessment Template
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INTRODUCTION TO COMPLETE THE ASSESSMENT With the help of this clinical diagnostic assessment template, people with lower back and other musculo-skeletal pain (plus employers, insurers, medical, fitness and manipulative therapy practitioners) will be able to gain a clearer appreciation of the underlying cause of the pain and more accurately prescribe the most appropriate rehab treatment – one that focuses on treating the underlying cause of the problem. As an individual you can work your way through the clinical diagnostic assessment yourself – with the help of someone to take photos of you in various diagnostic postures. We recommend you take the photos on a digital camera, smart phone or tablet. Crop the photos and then insert them in to the Clinical Diagnostic Assessment template – in the places as illustrated in this document. In the workplace, fitness centre, surgery or manipulative therapy rooms all it needs is someone to take people through the various assessments. This document illustrates in detail the nature and scope of the assessment. Once you’ve signed up to complete the assessment we’ll send you the Microsoft Word version of the template that you can complete on your own computer and email to us for evaluation and recommendations The clinical diagnostic assessment comes with an exercise prescription that treats the cause of the problem by loosening tight muscles, strengthening weak muscles and getting the skeleton back into better alignment. The exercise prescription is the most effective prescription there is for the treatment of most personally-generated musculo-skeletal dysfunctions. It’s a prescription that people can administer themselves. In fact it’s only they, themselves who can administer it. That’s why it’s the cheapest rehab program there is. Most joint and muscle pain is personally generated. In the case of lower back pain, tight muscles attached to the pelvis have taken the pelvis and the bones above it out of alignment. Only on the rates of occasions is lower back pain caused by a lack of rubbing, crunching, heating, vibrating, strapping, doping, surgery, stretching gadgets …! (If you’re a medical practitioner or rehab therapist you’ll be able to use the template to quickly gain an appreciation of the strength, flexibility and skeletal alignment of your clients and provide them with an exercise prescription that they, themselves can use to become pain free.)
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Having received the Microsoft Word template and completed the assessment: 1. Crop the photos and resize them to fit in the space available on the template. 2. Insert them into the Clinical Diagnostic Assessment template 3. Email the template to Global Back Care mailto:[email protected] 4. We’ll provide people who participate in the program with a download access link to the Global Back Care
suite of ebooks containing the exercises and videos designed to get you back into good musculo-skeletal health and pain free.
If the completed assessment is to large to send through as a Microsoft Word attachment, convert it to a pdf file. It’s frequently the case that people with low back pain also have other muscle and joint pain. Accordingly, I’ve included in this assessment, tests to determine the cause of pain in several other areas of the body, particularly neck, shoulders, hips and knees. How long will the assessment take? By the time the assessments have been completed and the completed template sent to us, the process will have taken at most couple of hours – about the same time it takes someone to drive to a therapeutic appointment, spend half an hour flipping through a 1997 Readers Digest in the waiting room, receive their treatment and then drive back home. Allow a couple of days for your provider to complete your report. John Miller Global Back Care mailto:[email protected]
Global Back Care Clinical Diagnostic Assessment Template
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INDEMNITY Before you start – a warning
The Musculo-skeletal Risk Factor Profile and the analytic postures in this Clinical Assessment Template have
been developed to provide people with a set of performance-based measures from which they can gauge the status of
their musculo-skeletal health.
For a high proportion of people in poor musculo-skeletal health, the underlying problem is a fitness problem, (not a
medical problem) one generated by a lack of strength and flexibility.
In this assessment you’ll be given a clear idea of which muscles are weak, which muscles are tight and which muscles
are likely to be the underlying cause of your back pain.
The premise is that weak and tight muscles move bones out of alignment. Joint and muscle pain is a symptom of this
mis-alignment. Unless you have been involved in a traumatic accident, it is highly unlikely that a single incident will
have brought about this misalignment.
At the end of the assessment you’ll be given a download link to the Pro-Active Rehab suite of ebooks containing the
exercises we recommend you do to get yourself back into a pain free state.
SAFETY INFORMATION – the fine print
The Clinical Diagnostic Assessment protocol has been developed by people qualified to provide you with fitness advice
and exercises that are safe for normal, healthy human beings and if done regularly are likely to lead to an improvement
in your musculo-skeletal health.
However, because we have no idea of your current physical condition we need to provide you with some safety advice
and request that you look after yourself during the assessments. The exercises and analytical postures included in the
assessment are well within the capability of normal fit and healthy people, especially those in good musculo-skeletal
health. If you’re not in good musculo-skeletal health proceed with caution.
To signify that you have read the safety information below, remove the � from the boxes.
1. There is a slight risk that you could injure yourself during this session. Whilst it is unlikely, you may
strain a muscle, tendon or ligament, particularly if you haven’t done any strength or flexibility
exercises for a long time. This is a risk you need to be aware of and one which we cannot shoulder. � �
2. You may feel stiff tomorrow, particularly if you haven’t done squats, situps or pressups for years. This
feeling of stiffness is normal for people who don’t have a regular exercise program. On the other hand,
you may feel looser at the end of the session and in following days. � �
4. You may be a bit tender for a day or two if you stretch – even gently – muscles that have been tight for
years. This is normal. However, by the end of the assessment you’ll have a fair idea of what you need
to do to keep yourself in good musculo-skeletal health. � �
5. If there is conjecture about the safety of some of the exercises we recommend, we will point out those
safety concerns. � �
6. If you don’t want to do an exercise, don’t do it. � �
7. If it hurts while doing an exercise, stop doing it immediately. � �
8. If you don’t think you should do an exercise, don’t do it. � �
9. If a doctor or manipulative therapist has said ‘Don’t do that exercise’, don’t do it. We’re not going to
argue with doctors and therapists in their absence. � �
10. Look after yourself. � �
Please sign on the dotted line to confirm that you’ve read this advice and are happy to participate in the exercise part of
this assessment.
Provider
You ………….……………………………. Date / /
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PERSONAL INFORMATION
Please complete the following details
Name:
Email address:
Phone number:
Skype address:
Age …….
Gender Male ���� Female ����
Weight Kg ………. Height cm ……….
Percent body fat ……………... If you have a set of bathroom scales that also measures
percent body fat, include that measure.
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OUTLINE OF THE PROBLEM(S)
First, tell us why you’re seeking a musculo-skeletal health clinical diagnostic assessment.
Tell us which parts of your body are causing you concern – ie which joints and muscles are
painful. Some areas maybe extremely painful, some just niggles. Give us a good description.
Let us know what you think is the cause of the problem(s).
Be as expansive as you wish.
Keep in mind that despite the fact that this assessment is directed principally at people with
lower back pain, the assessment is such that you’ll also come away with clues as to why you
have joint and muscle pain in other areas of your body.
Your comments:
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SPECIFIC JOINT CONDITION ASSESSMENT Exceptionally painful Painful Twinge Mostly pain free Score
1 2 3 4 5 6 7 8 9 10
1. Lower back. Rate the current condition of your lower back.
0 1 2 3 4 5 6 7 8 9 10
2. Upper back. Rate the current condition of your upper back.
0 1 2 3 4 5 6 7 8 9 10
3. Neck. Rate the current condition of your neck.
0 1 2 3 4 5 6 7 8 9 10
4. Right shoulder. Rate the current condition of your right shoulder.
0 1 2 3 4 5 6 7 8 9 10
5. Left shoulder. Rate the current condition of your left shoulder.
0 1 2 3 4 5 6 7 8 9 10
6. Right wrist. Rate the current condition of your right wrist and hand.
0 1 2 3 4 5 6 7 8 9 10
7. Left wrist. Rate the current condition of your left wrist and hand.
0 1 2 3 4 5 6 7 8 9 10
8. Right hip. Rate the current condition of your right hip.
0 1 2 3 4 5 6 7 8 9 10
9. Left hip. Rate the current condition of your left hip.
0 1 2 3 4 5 6 7 8 9 10
10. Right knee. Rate the current condition of your right knee.
0 1 2 3 4 5 6 7 8 9 10
11. Left knee. Rate the current condition of your left knee.
0 1 2 3 4 5 6 7 8 9 10
12. Right lower leg. Rate the current condition of your lower leg, and foot.
Do you suffer from shin splints, Achilles tendonitis …
0 1 2 3 4 5 6 7 8 9 10
13. Left lower leg. Rate the current condition of your lower leg, and foot. Do you suffer from shin splints, Achilles tendonitis …
0 1 2 3 4 5 6 7 8 9 10
14. Right foot. Rate the current condition of your right foot. Do you suffer from
heel pain, plantar fasciitis, malformed toes ….
0 1 2 3 4 5 6 7 8 9 10
15. Left foot. Rate the current condition of your left foot. Do you suffer from
heel pain, plantar fasciitis, malformed toes ….
0 1 2 3 4 5 6 7 8 9 10
/150
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TEN POINT MUSCULO-SKELETAL RISK SCREEN
Below is an outline of the tests in the Risk Screen. Complete the risk screen on the next page.
1. Current condition
This is a subjective assessment of how you perceive your
current, overall level of musculo-skeletal health. Take into
account aches and pains and limited mobility and function
compared with when you were ‘at your peak’.
2. Body composition.
How close are you to your ideal weight? You can estimate the
number of kilograms over your ideal weight. In a clinical
situation we’d use percent body fat.
3. Lower body strength - squat How many squats can you do ‘til exhaustion? Your bottom
must reach the crease at the back of your knees.
If you’ve got sore knees either don’t proceed or proceed with
caution.
4. Abdominal strength - sit-ups with feet ‘til exhaustion.
There is evenly divided conjecture about whether it is safe to
do situps with feet held. I believe the exercise is safe. Many
people cannot do 1 situp without their feet held. Proceed with
caution.
If it hurts, stop doing it
5. Upper body strength - press-ups ‘till exhaustion, men on toes,
women on front of thighs.
If you’ve got painfully sore shoulders either don’t do this
exercise or proceed with caution - and don’t do too many.
6. Flexibility - sit and reach
Sitting on the floor, with feet outstretched in front of you, see
how far down past your toes you can reach with your fingers.
Keep your knees straight.
7. Ability to sit up straight with legs crossed With legs crossed and hands clasped behind your back, see if
you can sit up straight without falling over backwards.
8. Shoulder function – wall test.
Stand with your back to the wall. Place your hands in the
surrender position with elbows, forearms, wrists and fingers
flat back on the wall.
Score 10 if you can do this with ease. Score low if you have
difficulty getting into this position or lower still if, when your
forearms are vertical they are a long way from the wall.
9. Strength training behaviour
Number of times a week you train
.
10. Flexibility training behaviour Number of times a week you train.
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TEN POINT MUSCULO-SKELETAL RISK SCREEN
Warning: If you don’t think you should do any of these exercises, don’t do them. If it hurts while you are doing any of
the exercises stop doing them immediately. Record your scores in the boxes on the right hand side of the page.
1. Current condition.
How would you rate the current condition of your musculo-skeletal system? Your score
>20 20 18 16 14 12 10 8 6 4 2
0 1 2 3 4 5 6 7 8 9 10
2. Body composition. Are you close to your ideal weight? Scores based % body fat body
M >40 <40 <36 <33 <30 <28 <26 <24 <22 <20 <18
W >50 <50 <46 <43 <40 <38 <36 <34 <32 <20 <28
Kilos >20 20 18 16 14 12 10 8 6 4 <4
0 1 2 3 4 5 6 7 8 9 10
Current weight ........... Percent body fat …………….. Ideal weight ……………….
3. Lower body strength - squat How many full squats can you do till exhaustion? Bottom must reach
crease at back of knees. Recommend you use a 30mm heel raise. # .............
>5 5 8 10 13 15 18 20 23 25 30
0 1 2 3 4 5 6 7 8 9 10
4. Abdominal strength - sit-ups with feet held to exhaustion. # ............
>5 5 8 10 13 15 18 20 23 25 30
0 1 2 3 4 5 6 7 8 9 10
5. Upper body strength - press-ups to exhaustion, men on toes, women
on front of thighs with knees, bottom and shoulders in a straight line. # ............
>5 5 8 10 13 15 18 20 23 25 30
0 1 2 3 4 5 6 7 8 9 10
6. Flexibility - sit and reach
Sitting on the floor, with feet outstretched in front of you, see how far down
past your toes you can reach with your fingers. Keep your knees straight.
Can't touch Fingers Palm Wrist
0 4 5 6 7 8 9 10
7. Ability to sit up straight with legs crossed With legs crossed and hands clasped behind your back, see if you can sit up straight. Just
being able to sit up with hands clasped scores 7/10.
Fall over when hands clasped behind back Just Easy
0 7 8 9 10
8. Shoulder function - wall test
Stand with you back to the wall. Place your hands in the surrender position with the
Back of your forearms, wrists and hands flat back on the wall.
Arms more than
10cms from the wall
Arms 10cm
from wall
Just Easy
0 3 4 6 7 8 9 10
9. Strength training behaviour
Do you have a regular and systematic strength training program either at home or at
the gym. Sessions per week.
0 1 2 3
0 1 2 3 4 5 6 7 8 9 10
10. Flexibility training behaviour
Do you have a regular and systematic flexibility training program either at home or at the gym. Sessions
per week.
0 1 2 3
0 1 2 3 4 5 6 7 8 9 10
The ‘pass mark’ is 70/100. Anyone scoring less than 50 either has, or
is at grave risk of succumbing to some sort of musculo-skeletal pain. TOTAL/100
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POSTURAL ANALYSIS
Get someone to take still photos (on a digital camera, smart phone or tablet) of you in various
diagnostic postures outlined in this section, crop the photos and then insert them into the Clinical
Diagnostic Assessment template.
1. Standing up straight - front on
Wearing shorts, T-shirt and bare feet, take a picture of yourself, standing up straight, front on and
with feet comfortably apart.
1. Standing up straight - front on
Image 1.
Insert a cropped and/or re-sized image here
Based on your own personal assessment, is your body in good alignment?
Are you perfectly in alignment or are you leaning to one side? Are the palms of your hands facing
the outside of your thighs or do you see mainly knuckles? Are your shoulders level? Are the tips of
your fingers level?
Poor form Good form
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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2. Standing up straight - side on
Wearing shorts, T-shirt and bare feet, take a picture of yourself side on - standing up straight with
feet comfortable apart. Don't even think of holding your abdomen in!
2. Standing up straight - side on
Image 2.
Insert a cropped and/or re-sized image here
Based on your own personal assessment, is your body in good alignment?
Poor Excellent
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
L
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3. Can you put a sock on your RIGHT foot while standing on your left leg?
Standing on your left leg, can you bend down and put a sock on your right foot without falling over?
Your right knee must stay close to the mid line of your body so your foot, knee and hip are all in a
straight line.
3. Putting a sock on your right foot with
right knee close to your mid line.
Image 3.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Poor Excellent
Couldn't
do it
With difficulty Easy
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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4. Can you put a sock on your LEFT foot while standing on your right leg?
Standing on your right leg, can you bend down and put a sock on your left foot without falling over?
Your left knee must stay close to the mid line of your body so your foot, knee and hip are all in a
straight line.
4. Putting a sock on your left foot with left
knee close to your mid line.
Image 4.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task. Poor Excellent
Couldn't
do it
With difficulty Easy
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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5. Calf and hamstring flexibility test. Can you sit up straight against a wall
Sit up against a wall, legs straight and backs of knees on the floor. Push your bottom back as close
to the wall as you can.
Let us know which muscles feel tight when you push your bottom closer to the wall.
5. Sitting up straight against a wall
Image 5.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Bottom, cms from the wall.
Poor Excellent
20 18 16 14 12 10 8 6 4 2 0
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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6. Right hamstring flexibility test against a wall: right leg against the wall
Get in close to the corner of a wall, or a doorway. Lie down on your back with your left leg flat on
the floor. Keeping your right leg straight, put the heel on the wall and then gradually edge your
bottom in towards the wall as far as you can.
Take a photo at the point where you can’t move your bottom any closer into the wall. We're
interested to see if there is a gap between your bottom and the wall and if there is, how large it is.
Make sure you keep your legs straight.
6. Right hamstring function test
Image 6.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Bottom, cms from the wall
Poor Excellent
20 18 16 14 12 10 8 6 4 2 0
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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7. Left hamstring flexibility test against a wall: left leg against the wall
Get in close to the corner of a wall, or a doorway. Lie down on you back with your right leg flat on
the floor. Keeping your left leg straight, put the heel on the wall and then gradually edge your
bottom in towards the wall.
Take a photo at the point where you can’t move your bottom any closer into the wall. We're
interested to see if there is a gap between your bottom and the wall and if there is, how large it is.
Make sure you keep your right leg straight and flat on the floor.
7. Left hamstring function test
Image 7.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Bottom, cms from the wall
Poor Excellent
20 18 16 14 12 10 8 6 4 2 0
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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8a. Right buttock function test – front on
Can you sit up exceptionally straight with your legs crossed; left leg under the right, right leg over
the left and hands clasped behind your back?
8a. Right buttock function test - front on
Image 8a.
Insert a cropped and/or re-sized image here
Poor Excellent
Couldn’t do it – fell over backwards. Leaning to one
side.
Sitting up
straight
0 1 2 3 4 5 6 7 8 9 10
8b. Right buttock test - side on
8b. Right buttock function test – side on
Image 8b.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Poor Excellent
Couldn’t do it – fell over backwards. Only just. Back
in a ‘C’ shape.
Easy and up straight
with hollow in lumbar
spin
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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9a. Right buttock function test - side on:
Can you sit up exceptionally straight with your legs crossed; left leg under the right and right leg
over the left - and hands clasped behind your back?
9a. Left buttock function test - front on.
Image 9a.
Insert a cropped and/or re-sized image here
Poor Excellent
Couldn’t do it – fell over backwards. Leaning to
one side.
Sitting up
straight
0 1 2 3 4 5 6 7 8 9 10
b. side on
9b. Left buttock function test - side on
Image 9b.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Poor Excellent
Couldn’t do it – fell over backwards. Only just. Back
in a ‘C’ shape.
Easy and up straight
with hollow in lumbar
spin
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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10. Hip crossover: twisting to the left
Start lying on your back with feet flat and knees up. Put the side of the heel of your right foot up
near the top of your left thigh (but not on the knee). Then drop the left knee and right foot onto the
floor on the left side of your body.
10.a Hip crossover starting position. Ideally right
lower leg should be at 90 degrees to left upper leg.
10b. Hip crossover – twisting to the left. Aim to get
left knee and right foot comfortably on floor
Image 10.a
Insert a cropped and/or re-sized image here.
Image 10.b
Insert a cropped and/or re-sized image here.
Give yourself a personal rating on how well you performed the task.
10.a
Poor Excellent
Right lower leg a long
way from being 90
degrees to left upper leg.
Right hip tight. Right lower leg at 90 degrees to
left upper leg.
0 1 2 3 4 5 6 7 8 9 10
10.b
Poor Excellent
Couldn’t get knee and
foot to rest on the floor –
too painful.
Only just -
right side of
body tight.
Left knee and right foot easily
on the floor.
0 1 2 3 4 5 6 7 8 9 10
Pain experienced when right buttock massaged vigorously.
Poor Excellent
Excruciatingly painful Painful No pain at all.
0 1 2 3 4 5 6 7 8 9 10
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Your comments:
My comments:
11. Hip crossover: twisting to the right
Start lying on back with feet flat and knees up. Put the side of the heel of your left foot up near the
top of your right thigh (but not on the knee). Then drop the right knee and left foot onto the floor on
the right side of your body.
Comment on whether you are having difficulty getting the knee and foot onto the floor. Many
people can't do this, their back and hips are too painful.
Get the person who's taking the pictures to vigorously massage your right buttock. Record below
whether or not it was painful.
11.a Hip crossover starting position. Ideally left lower
leg should be at 90 degrees to right upper leg.
11b. Hip crossover – twisting to the right. Aim to get
right knee and left foot comfortably on floor
Image 11.a
Insert a cropped and/or re-sized image
Image 11.b
Insert a cropped and/or re-sized image
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Give yourself a personal rating on how well you performed the task.
Poor Excellent
Left lower leg a long way
from being 90 degrees to
right upper leg.
Left hip tight. Left lower leg at
90 degrees to
right upper leg.
0 1 2 3 4 5 6 7 8 9 10
Poor Excellent
Couldn’t get knee and
foot to rest on the floor –
too painful.
Only just - left
side of body
tight
Right knee and
left foot easily on
the floor.
0 1 2 3 4 5 6 7 8 9 10
Pain experienced when left buttock massaged vigorously.
Poor Excellent
Excruciatingly painful Painful No pain at all.
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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12. Right hip function
Along with the hip crossover exercise, this exercise will provide you with clues as to the cause of
any dysfunction in your hips.
To check your right hip function, lie on your back with your left leg on an ottoman (or a chair) and
the right foot on the floor, leg bent at the knee, with your foot resting against the ottoman.
Move the right knee down toward the floor. If it's functioning well, you'll be able to rest the knee on
the floor with ease. If it is dysfunctional it won't go anywhere near the floor.
Take a photo to see how close to the floor your knee can go.
Report on how well you can do it, whether it’s painful or not and if you notice any differences
between the sides.
12. Right hip function test.
Image 12.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Knee cms from the floor.
Poor Excellent
20 18 16 14 12 10 8 6 4 2 0
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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13. Left hip function
Along with the hip crossover exercise, this exercise will provide you with clues as to the cause of
any dysfunction in your hips.
To check your left hip function, lie on your back with your right leg on an ottoman (or a chair) and
the left foot on the floor, leg bent at the knee, with your foot resting against the ottoman.
Move the left knee down toward the floor. If it's functioning well, you'll be able to rest the knee on
the floor with ease. If it is dysfunctional it won't go anywhere near the floor.
Take a photo to see how close to the floor your knee can go.
Report on how well you can do it, whether it’s painful or not and if you notice any differences
between the sides.
13. Left hip function test
Image 13.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Knee cms from the floor.
Poor Excellent
20 18 16 14 12 10 8 6 4 2 0
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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14. Super buttock and thigh stretch: twisting to the left
Wear long trousers, shoes and socks for this test.
Lie on your back with your legs straight. Swing your straight right leg over your body so your right
foot touches the floor. Even though your left leg will bend slightly when you do this, aim to keep
the left foot in roughly the starting position.
Once the right shoe is on the floor on the left side of your body, see if you can grab hold of the toe
of the shoe on the straight right leg with your left hand.
If you can’t grab the toe of your shoe, either grab the laces of your shoe, your sock or the leg of
your trousers. Just make sure the right leg stays straight and your right shoulder and arm are flat on
the floor.
Take the photo at your ‘most stretched’ position.
14. Test of right side of body flexibility
Image 14.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Poor form Good form
Trousers held near knee Cuff of
trousers Sock Laces
Toe -
easy
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
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15. Super buttock and thigh stretch: twisting to the right
Wear long trousers, shoes and socks for this test.
Lie on your back with your legs straight. Swing your straight left leg over your body so your left
foot touches the floor. Even though your right leg will bend slightly when you do this, aim to keep
the right foot in roughly the starting position.
Once the left shoe is on the floor on the right side of your body, see if you can grab hold of the toe
of the shoe on the straight left leg with your right hand.
If you can’t grab the toe of your shoe, either grab the laces of your shoe, your sock or the leg of
your trousers. Just make sure the right leg stays straight and your right shoulder and arm are flat on
the floor.
Take the photo at your ‘most stretched’ position.
15. Test of left side of body flexibility.
Image 15.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Poor form Good form
Trousers held near knee. Cuff of
trousers Sock Laces
Toe -
easy
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
Global Back Care Clinical Diagnostic Assessment Template
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16. Feet over head
Lying on your back, can you take your feet over your head and grab hold of your toes – with back
of hands on the floor.
This is an exercise you would have had no difficulty doing as a child.
Take a photo of the furthest point you can reach.
16. Heels over head
Image 16.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Poor Excellent
Couldn’t do it at all. Feet 30cms from
the floor.
Easy. Feet touch the floor
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
Global Back Care Clinical Diagnostic Assessment Template
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17. Tight muscles at top of buttock - in prone frog position
This position takes a bit of getting in to.
Start on hands and knees with your knees as wide apart as you can get them.
With lower legs up off the floor, take your body forward so the front of your abdomen is pressing in
to the floor and your chin is resting on your hands.
Place the soles of your feet together and let them hang toward the floor. Don't worry if they don't
reach the floor. Most people find their feet won't touch the floor.
Get someone to stand over you and dig their thumbs into your buttock muscles in the places
indicated by the red spots.
Observe how tender those spots are and whether one side is more painful than the other.
17. Prone frog test of groin muscle flexibility
Image 17.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Poor Excellent
Feet further than 10cms
from the floor
Feet within
10cms of the
floor
Feet touching
floor.
0 1 2 3 4 5 6 7 8 9 10
Pain experienced when right buttock massaged vigorously.
Poor Excellent
Excruciatingly painful Painful No pain at all.
0 1 2 3 4 5 6 7 8 9 10
Pain experienced when left buttock massaged vigorously.
Poor Excellent
Excruciatingly painful Painful No pain at all.
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
Global Back Care Clinical Diagnostic Assessment Template
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18. Right quadriceps function - front on and side on.
This test will also assist in determining the cause of knee pain. Do this test with shoes on.
Stand about 30cms away from a bench about the same height as a kitchen bench. You may need
something to hold onto for balance.
Place the toe of your right shoe on the bench. Stand up straight with a hollow in your lumbar spine
and lean back as far as you can toward the bench.
18. Right quadriceps function test:
front on and side on.
Image 18.
Insert a cropped and/or re-sized images here
Give yourself a personal rating on how well you performed the task.
Poor Excellent
Knees 20cms
or more apart.
Knees 10cms
or more apart.
Knees less then
5cms apart
Knees
together
0 1 2 3 4 5 6 7 8 9 10
Pain experienced when leaning back.
Poor Excellent
Excruciatingly painful Painful No pain at all.
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
Global Back Care Clinical Diagnostic Assessment Template
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19. Left quadriceps function - front on and side on.
This test will also assist in determining the cause of knee pain. Do this test with shoes on.
Stand about 30cms away from a bench about the same height as a kitchen bench. You may need
something to hold onto for balance.
Place the toe of your left shoe on the bench. Stand up straight with a hollow in your lumbar spine
and lean back as far as you can toward the bench.
19. Right quadriceps function test:
front on and side on.
Image 19.
Insert a cropped and/or re-sized images here
Give yourself a personal rating on how well you performed the task.
Poor Excellent
Knees 20cms
or more apart.
Knees 10cms
or more apart.
Knees less then
5cms apart
Knees
together
0 1 2 3 4 5 6 7 8 9 10
Pain experienced when leaning back.
Poor Excellent
Excruciatingly painful Painful No pain at all.
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
Global Back Care Clinical Diagnostic Assessment Template
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20. Knee and ankle function
This exercise will really let you know what the condition of your ankles and knees is like.
Kneel down with your feet underneath your bottom and the laces of your shoes pressed against the
floor.
Lean back as far as you can.
20. Knee and ankle function test.
Image 20.
Insert a cropped and/or re-sized image here
Give yourself a personal rating on how well you performed the task.
Pain experienced when leaning back.
Poor Excellent
Excruciatingly painful
or couldn’t do it at all. Painful No pain at all.
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
Global Back Care Clinical Diagnostic Assessment Template
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21. Shoulder function
Stand with your heels, backside and shoulders against the wall.
We're interested to see whether you can get the back of your forearms, wrists, hands and fingers
comfortably flat against the wall when in the 'surrender' position.
21. Shoulder function test
Image 21.
Insert a cropped and/or re-sized image here
How do your shoulders feel?
Poor Excellent
A lot of
pain
Some
pain
Loose – no
pain
0 1 2 3 4 5 6 7 8 9 10
How far are your forearms, wrists and fingers off the wall when they are vertical?
Cms from the wall.
Poor Excellent
20 17 15 13 11 9 7 5 3 1
Flat
against
wall
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
Global Back Care Clinical Diagnostic Assessment Template
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22. Neck function
Stand with your heels, backside and shoulders flat against the wall. Then put your head against the
wall. Does it go flat back against the wall so you can see the skirting on the other side of the room,
or do you look up toward the ceiling?
When your eyes are looking straight ahead, how far is your head away from the wall.
22. Neck function test
Image 22.
Insert a cropped and/or re-sized image here
How does your neck feel?
Poor Excellent
A lot of
pain
Some
pain
Loose – no
pain
0 1 2 3 4 5 6 7 8 9 10
Head: cms from the wall when looking straight ahead.
Poor Excellent
10 9 8 7 6 5 4 3 2 1 0
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
Global Back Care Clinical Diagnostic Assessment Template
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23. Sitting at your desk
We'd like to see a picture of you sitting at your desk working on your computer.
Get someone at work to take the picture of you when you are least expecting it.
26. Sitting at desk posture
Image 23.
Insert a cropped and/or re-sized image here
Our assessment
Poor Excellent
0 1 2 3 4 5 6 7 8 9 10
Your comments:
My comments:
You’re all done
Email the completed assessment to me, then sit back with your feet up for a couple of days and I’ll
be right back to your with the report.
John Miller
Global Back Care Clinical Diagnostic Assessment Template
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IMAGE OVER VIEW
At the completion of the assessment you should have uploaded the following 26 images.
1. Standing up straight -
front on
2. Standing up straight -
side on
3. Putting sock on right foot 4. Putting sock on left foot
5. Calf and hamstring flexibility
6. Right hamstring flexibility 7. Left hamstring flexibility
Global Back Care Clinical Diagnostic Assessment Template
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8a. Right buttock
function - front on
8b. Right buttock
function - side on
9a. Left buttock
function - front on
9b. Left buttock
function - side on
10. Hip crossover to the left 11. hip crossover to the right
12. Right hip function
13. Left hip function
14. Right side super butt and thigh stretch 15. Left side super hip and thigh stretch
Global Back Care Clinical Diagnostic Assessment Template
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16. Back side of body flexibility. 17. Groin muscle flexibility
18a. Right quadriceps
flexibility - front on
18b. Right quadriceps
flexibility - side on
19a. Left quadriceps
flexibility - front on
19b. Left quadriceps
flexibility - side on
20. Knee and ankle joint function
21. Shoulder function 22. Neck function 23. Work station assessment
Global Back Care Clinical Diagnostic Assessment Template
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